Diaphysis Of Long Bones Research Articles

A rare variant of Caffey′s disease - X-rays, bone scan and FDG PET findings

An 18-month-old boy with history of fever of 4 months duration and with swelling of the limbs was referred for a bone scan. There were multiple swellings over his upper and lower limbs, with bowing of the lower limbs. His radiological skeletal survey revealed marked periosteal new bone formation surrounding the diaphysis of long bones. A bone scan done with 99m Tc-MDP showed diffusely increased tracer uptake in all the long bones. A fluorodeoxyglucose positron emission tomography (FDG PET) scan done to assess the metabolic activity showed patchy FDG uptake in the long bones, ankle joint and anterior ends of few ribs. His clinical and imaging findings led to the diagnosis of Caffey's disease.

Fracture healing after reamed and unreamed intramedullary nailing in sheep tibia

Intramedullary nailing is a well-established method for stabilisation of long-bone shaft fractures. It is still a controversy as to whether the procedure should be done by an unreamed or reamed technique. In the present animal study, 24 sheep were treated with intramedullary nailing. Midshaft fractures (Arbeitsgemeinschaft für Osteosynthese (AO) type 42-A2/3) were created. Eight sheep were treated with an unreamed nailing technique (UN), a further eight sheep underwent tibia nailing by the reamed technique using the conventional AO reaming system (RC) and in a further eight sheep, reamed nailing was performed using an experimental reaming system (RE). Intra-operatively, the intramedullary pressure was measured and, during a healing time of 10 weeks, the growth of callus formation was labelled with fluorescence markers after 4 and 6 weeks. After 10 weeks, the animals were euthanised and the quality of fracture healing was determined by recording stiffness in torsion, antero-posterior and mediolateral bending and the load at yield. In addition, the callus formation at the fracture zone was evaluated by fluorescence microscopy and macroradiographs. The results showed a decrease of intramedullary pressure when reamed nailing was performed with the RE (72.5 mmHg) system compared with the conventional AO reaming system (227 mmHg). Mechanical testing did not reveal any significant differences either for torsional or bending stiffness or for load at yield for any of the three procedures. Histological evaluation showed a similar callus formation for the UN group and the RE group. Callus formation in the UN (65 mm 2) and RE (63 mm 2) groups showed a higher increase during the first 6 weeks than those treated with the conventional AO reaming system (27 mm 2). This means that, especially during the first weeks of fracture healing, damage to the bone by the reaming process can be reduced by reaming with a reaming device with lowered cutting flutes and smaller drive-shaft diameter. Intramedullary pressure can be significantly reduced by using reaming systems with reduced drive-shaft diameters and deepened cutting flutes. In the early phase of fracture healing, callus formation can be influenced positively when using the RE system.

Multiple bone tuberculosis in a child from predynastic Upper Egypt (3200 BC)

AbstractTuberculosis, one of the most ancient human diseases, was present in ancient Egypt and has been observed since predynastic times. Excavations in the predynastic to early dynastic necropolis of Adaima, Upper Egypt (3500–2700 BC) led to the discovery of a number of remarkably well‐preserved skeletons of children. The skeletal remains of a 4.5–5‐year‐old child dated from Nagada III A2 (3200–3100 BC) displayed various lesions on the post‐cranial skeleton: spondylitis on the thoracic (T12) and lumbar (L1) vertebrae, partial lytic destruction of the right radio‐ulnar joint, lytic lesions on the scapula and a clavicle, dactylitis on the short bones of hands and feet, enlargement (spina ventosa) and periosteal new bone formation on the long bones. Radiographs show well‐defined radiolucent (cyst‐like) lesions in the metaphysis and the diaphysis of long tubular bones (ulna, radius, femur, tibia, fibula). The lesions recorded during macroscopic and radiological analysis strongly suggest a case of multiple bone tuberculosis. The occurrence of this case of tuberculosis in a child provides a picture of a period where tuberculosis must have been endemic throughout the population living during the origins of urban settlement in Upper Egypt during the predynastic period. Copyright © 2009 John Wiley & Sons, Ltd.

Bone Scintigraphy in Engelmann-Camurati Disease

Abstract: Engelmann-Camurati Disease is a rare bone disorder with low incidence (1:1 million births). In this article, we describe the case of a patient who presented with pain in the upper and lower limbs. She had an important anxiety-depressive component in relation to pain and limitation of physical activity, crying, and anxiety symptoms. We carried out a bone scan that showed abnormal uptake of tracer in the diaphysis of long bones. Radiographic findings included cortical symmetrical thickening in the same locations, and general biochemistry was abnormal.

Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults

Introduction Injury is a major cause of death and disability in children and young adults worldwide. X-rays are routinely performed to evaluate injuries with suspected fractures. However, the World Health Organisation estimates that up to 75% of the world population has no access to any diagnostic imaging services. Use of clinician-performed point-of-care ultrasound to diagnose fractures is not only feasible in traditional healthcare settings, but also in underserved or remote settings. Our objective was to determine the accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults presenting to an acute care setting. Methods We conducted a prospective cohort study of patients aged <25 years that presented to emergency departments with injuries requiring X-rays or CT for suspected fracture. Paediatric emergency physicians with a 1 h training session diagnosed fractures by point-of-care ultrasound. X-rays or CT were used as the reference standard to determine test performance characteristics. Results Point-of-care ultrasound was performed on 212 children and young adults with 348 suspected fractures. Forty-two percent of all bones imaged were non-long bones. The prevalence rate of fracture was 24%. Overall: sensitivity—73% (95% CI: 62–82%), specificity—92% (95% CI: 88–95%); long bones: sensitivity—73% (58–84%), specificity—92% (86–95%); non-long bones: sensitivity—77% (58–90%); specificity—93% (87–97%); age ≥ 18 years: sensitivity—60% (39–78%), specificity—92% (87–96%); age < 18: sensitivity—78 (65–87%), specificity—93% (87–95)%. Majority of errors in diagnosis (>85%) occurred at the ends-of-bones. Conclusions Clinicians with focused ultrasound training were able to diagnose fractures using point-of-care ultrasound with a high specificity rate. Specificity rates to rule-in fracture were similar for non-long bone and long bone fractures, as well as in skeletally mature young adults and children with open growth plates. Clinician-performed point-of-care ultrasound accuracy was highest at the diaphyses of long bones, while most diagnostic errors were committed at the ends-of-bones or near joints. Point-of-care ultrasound may serve as a rapid alternative means to diagnose midshaft fractures in settings with limited or no access to X-ray.

Uncommon case of tibial bone infarction associated with juvenile idiopathic arthritis

Bone infarction refers to aseptic osteonecrosis occurring in the metaphysis and diaphysis of long bones. Hemoglobinopathies, sickle cell disease, and Gaucher's disease are usually found. Bone infarction is rarely idiopathic. Magnetic resonance imaging has proved to be more specific to identify bone infarction.We report an exceptional case of a unique idiopathic bone infarction of distal tibia, occurring unusually in a patient with juvenile idiopathic arthritis, without major risk factors of osseous infarct, and with atypical clinical and biological abnormalities.

Nutritional secondary hyperparathyroidism in two cats

Two three-month-old, intact female Abyssinian cats were presented with a history of lameness, constipation and ataxia. The cats had been fed a diet composed almost exclusively of meat. Both showed severe osteopenia and multiple pathological fractures on radiography. Following euthanasia of the more severely affected cat, postmortem examination revealed changes consistent with nutritional secondary hyperparathyroidism and fibrous osteodystrophy, such as cortical thinning, massive connective tissue invasion in the diaphysis of long bones, and hypertrophy of the chief cells in both parathyroid glands. After introducing a balanced commercial diet to the surviving cat, bone mineralisation improved from the baseline value, and at subsequent examinations at three, six and 22 weeks later, as indicated by bone mineral density measurements obtained by dual-energy X-ray absorptiometry and computed tomography.

Osteosarcoma Aspects of the Dog's Axial Skeleton: Clinical, Radiological and Histopathological Aspects

Osteosarcoma is a malignant tumour form which modifies (troubles) especially big dogs breeds. Regarding the location at the level of different bony structures at was found out a higher frequency of osteosarcoma in long bone diaphysis and metaphyses and more reduced in the skull and spine bones. The reduced incidence of osteosarcoma forms localized in the axial skeleton represents the reason of this paper. The animals were investigated from the clinical, radiological and histopathological point of view in the clinics of the Bucharest Faculty of Veterinary Medicine. Three cases with axial osteosarcom are presented in this paper: -a 7-year-old male Pekingese with fibroblastic osteosarcoma localized at L6 level, -a 10-year-old female Romanian Shepherd’s localized in the right parietal level, -an 18-year-old male mixed breed dog with fibroblastic osteosarcoma localized in the right dorso-lateral region of the nasal bone. The neoplasic aspects localized at the level of the axial skeleton, considering the topographic peculiarities regarding their closeness with the vital tissues (spinal marrow, encephalon) present a reduced opportunity for a biopsy in most cases. Consequently the cytological aspects which determine us to have a suspicion regarding these neoplasic aspects are in most cases, difficult to obtain by aspiration biopsy. The method to extract the suspect bony tissue was carried out by excisional biopsy, with general anaesthesia, and the biological matter taken out was histologically examined obtaining this a diagnosis of certainty.

The association between intracranial tumours and multiple dyschondroplasia (Ollier’s disease or Maffucci’s syndrome): do children and adults differ?

In Ollier's disease (OD) and Maffucci's syndrome (MS), there is deforming dysplasia of cartilage, primarily but not exclusively involving the metaphyses and diaphyses of long bones. In a minority of patients with either of these rare syndromes, dysplasia can lead to sarcomatous degeneration, producing chondrosarcomas. There also appears to be an association with other neoplasms, which can include intracranial tumours. The primary objective of the current paper was to compare children/adolescents who have either OD or MS and an intracranial malignancy with their adult counterparts. All relevant cases in the medical literature were identified by electronically searching PubMed, SciSearch, Scientific Commons, Springer Link, and Google. Translate DotNet and Babelfish were used to translate non-English text. Non-parametric Pearson chi-square analyses were used to compare youths versus adults with respect to gender and geographic distribution (by continent), tumour histology and site of lesion, and the underlying enchondromatosis syndrome (OD vs. MS). All tests were 2-tailed, and P < 0.05 represented a statistically-significant difference. Forty-six patients with 47 intra-cranial malignancies were identified, with nine of the patients being 18 years old or less and categorized as youths. The incidence of intracranial chondrosarcomas peaked in the fourth decade of life, in parallel with the peak number of MS cases; conversely, both non-sarcomas and OD peaked in the third decade of life. Six of nine youths (67%) versus 17 of 36 adults with gender data (47%) were female (P = 0.30). There was no difference in geographic distribution by continent (P = 0.82). Four youths (44%) versus 16 adults (43%) had a chondrosarcoma (P = 0.95), and there was no statistically significant difference by tumour site (P = 0.42). However, seven (77%) of the youths had Ollier's disease as their underlying enchondromatosis syndrome, versus just 17 (46%) of the adults, a difference that approached statistical significance (P = 0.086). The association between enchondromatosis and intracranial malignancy seems to be roughly the same in youths versus adults, though Ollier's disease cases appear to predominate among youths.

Pediatric thalamic glioblastoma associated with Ollier disease (multiple enchondromatosis): a rare case of concurrence

Ollier disease and Maffucci syndrome are rare syndromes in which there is deforming dysplasia of cartilage, primarily but not exclusively involving the metaphyses and diaphyses of long bones. In a minority of patients, dysplasia can lead to sarcomatous degeneration, producing chondrosarcomas. There also appears to be an association with other neoplasms. Little has been written about the association between Ollier disease and intracranial tumors, and these papers have largely consisted of case reports in adults. The authors present the case of a 6-year-old girl with left arm osseous changes consistent with Ollier disease and a biopsy-proven thalamic glioblastoma multiforme. They then examine the co-occurrence of brain tumors in conjunction with a dyschondroplasia syndrome in children and adolescents to assess the presentation, treatment offered, and disease course of similar cases. Eight other such cases were identified, 6 in patients with Ollier disease (ranging in age from 7 to 18 years), and 2 with Maffucci syndrome (both in late adolescence). Including our own patient, 7 of the 9 cases of comorbid dyschondroplasia and intracranial malignancy occurred in girls. Some patients presented soon after the acute onset of symptoms, and others had a more subtle, protracted course over as many as 2 years. Some tumors were deemed resectable and others not. In only 1 instance was follow-up beyond 1 year reported.

Mice expressing GFP and CreER in osteochondro progenitor cells in the periosteum

We generated Prx1CreER-GFP transgenic mice that express tamoxifen-inducible Cre recombinase and GFP under the control of a 2.4 kb Prx1 promoter. The transgene is expressed in osteochondro progenitor cells in the developing limb buds and in a subpopulation of periosteal cells that is closely associated with the cortical bone. GFP-expressing cells isolated from the diaphyses of long bones by cell sorting express multiple markers of periosteal cells, including Prx1, Fgf18, Tenascin-W, Periostin, and Thrombospondin 2. In addition, these cells undergo chondrogenic and osteogenic differentiation in culture upon induction. Cell fate analysis using the Rosa26 LacZ reporter indicated that transgene-expressing cells give rise to some of the chondrocytes and osteoblasts in the fracture callus. Collectively, these observations strongly suggest that the transgene-expressing cells are osteochondro progenitor cells in the periosteum. The established Prx1CreER-GFP mice would offer novel approaches for analyzing the functions of periosteal cells in vitro and in vivo.

Doença de Camurati-Engelmann: manifestações típicas de uma doença rara

A displasia diafisária progressiva ou doença de Camurati-Engelmann é uma doença rara, caracterizada por dor e fraqueza muscular dos membros afetados e espessamento progressivo da cortical diafisária dos ossos longos. Os autores descrevem o caso clínico de um doente com manifestações iniciais da doença na infância, mas cujo diagnóstico só foi estabelecido durante a idade adulta, depois de evoluída a doença e após surgirem as mesmas manifestações em um dos filhos. Salienta-se a dificuldade no diagnóstico e a relevância do diagnóstico diferencial com outras doenças que cursam com osteoesclerose e/ou hiperostose. Na literatura é rara a descrição da sua evolução ao longo dos anos.

Distinguishing between the bone fragments of medium-sized mammals and children. A histological identification method for archaeology

In archaeology, it is not always possible to identify bone fragments. A novel approach was chosen to assess the potential of histology as an identification tool. Instead of studying a few bones of different categories from many species, this study concentrated on the diaphyses of long bones in four species of comparable size which are relevant to archaeology; young humans, pigs, sheep and goats, to broaden the insight into variations in diaphyseal bone structure within and between these species. A general difference in the primary bone structure was found between children older than one year and the three medium-sized mammals, namely lamellar vs. fibro-lamellar primary bone. Although, the diaphyseal bone structure of children below the age of one year also showed (developing) fibro-lamellar bone, its composition was distinctive from the medium-sized mammals. A difference in the secondary bone structure was also observed. Connecting (Volkmann's) canals, giving the secondary bone a reticular aspect, were seen in the medium-sized mammals but not in the young human long bones. To confirm the validity and applicability of these observed histological differences, a blind test was conducted on 14 diaphyseal fragments of identified long bones from archaeological sites. The results were very promising. All the bone fragments were correctly attributed using the difference in primary bone structure, even when the bone was severely degraded.

Strategies for the analysis of osteitic bone defects at the diaphysis of long bones.

Septic diseases of the bone and the immediate surrounding soft tissue, i.e., osteitis, belong to the most alarming findings in recent traumatology and orthopedic surgery. The paramount goal of this therapy is to preserve the stable weight-bearing bones while maintaining a correct axis and proper working muscles and joints, in order to avoid permanent disability in the patient. “State-of-the-art” therapy of osteitis/osteomyelitis therapy has two priorities: eradication of the infection and reconstruction of bone and soft tissue. Surgical treatment of the affected bone segments and soft tissue, followed by reconstructive methods, continues to be the main basic therapy. It is often extremely difficult to decide whether the affected bone segment has to be resected, or whether bone continuity can be preserved. The following paper provides strategies and guidance to help guide decisions in this complex and challenging area.

Erdheim–Chester disease: case report with unique postmortem magnetic resonance imaging, high-resolution radiography, and pathologic correlation

Erdheim–Chester disease is an infiltrative form of histiocytosis characterized by replacement of normal tissues by lipid-laden histiocytes. The disease typically infiltrates the medullary portion of the diaphysis and metaphysis of long bones, producing a characteristic radiological pattern dominated by bone sclerosis. It usually affects adults of 40 years of age with a clinical spectrum ranging from an asymptomatic focal bone lesion to multisystemic disease. This case report documents unique imaging and pathologic findings of Erdheim–Chester disease using close postmortem pathologic-imaging correlation.

Telescope Allograft Method to Reconstitute the Diaphysis in Limb Salvage Surgery

We propose a surgical technique for structural allograft reconstitution of the diaphysis of long bones, maximizing surface contact between host and allograft bone. This method, analogous to a telescope, overlaps the graft and host bone, theoretically increasing bone surface contact substantially. We report the outcome of 22 telescoped allograft junction sites in 19 patients who lacked sufficient host bone to accommodate a regular-length stemmed implant. This joint-sparing reconstruction preserved 15 of 16 adjacent joints at risk for replacement. Five patients needed additional surgery, but none for nonunion. The diaphyseal length could be reconstructed enough so that a short prosthesis (less than the critical 40% of total bone length) could be used. This biologic method to reconstruct major segments of the diaphysis is best suited for patients with quantitatively or qualitatively deficient residual bone stock after tumor resection or prosthetic revision. We believe it is an excellent technique for revision knee megaprostheses when there is a short remnant of proximal femur. Level IV, therapeutic study.

Giant cell tumour in the diaphysis of radius – a report

BackgroundWe present a case of a 35 yrs old female who presented with swelling over her forearm. This is a rare case of a giant cell tumour in a nonepiphyseal region.MethodsCase report and presentation of clinical, radiological and histological data on single case of giant cell tumour of diaphysis of radius.ResultsAlthough age, clinical features and radiological features are helpful, it is still the histology that helps to clinch the diagnosis.ConclusionA thorough literature search and an exhaustive online search using various search engines revealed seven reported cases of giant cell tumours in the diaphysis of long bones. We reiterate the fact that irrespective of the location, a giant cell tumour should be diagnosed based on its histology.

Treatment of Extraspinal Painful Bone Metastases with Percutaneous Cementoplasty: A Prospective Study of 50 Patients

The aim of this study was to assess the efficacy of percutaneous cementoplasty (PC) with polymethylmethacrylate (PMMA) in painful extravertebral lytic bone metastases not responding to conventional therapy. Fifty patients (25 females), mean age 64.7 +/- 11.2 years, underwent PC after giving informed consent. Procedures were performed under fluoroscopy (1/50) or combined fluoroscopy-CT (49/50) guidance in local anesthesia or under deep sedation in 7 patients with large metastases who underwent radiofrequency thermoablation (RFA) in the same session. Seventy lesions were treated (1-6 per patient; average, 1.4 +/- 0.9), arranging in size from 1 to 10 cm (average, 3.6 +/- 2.1 cm). Mean volume of PMMA per lesion was 5.9 +/- 3.2 ml (range, 1.5-15.0 ml). Pain was prospectively evaluated on an 11-point visual analog scale (VAS) before and after the procedure (follow-up, 15 to 36 months). Mean VAS score dropped from 9.1 +/- 1.2 (range: 6-10) to 2.1 +/- 2.5 (range: 0-9). Mean VAS difference was 7.0 +/- 2.3 (range, 1-10; p \ 0.0001, Wilcoxon signed rank test). Forty-seven of the 50 patients (94%) suspended narcotic drugs, in 22 (44%) pain was controlled with a nonsteroidal anti-inflammatory drug, in 25 (50%) analgesic therapy was suspended, and 13 of 50 (26%) had complete pain regression. In 3 of the 50 patients (6%) pain was not improved. No statistical difference between osteoplasty and osteoplasty plus RFA was found (p = 0.8338, Mann-Whitney test). No complications arose during the procedure. Two patients with metastases in the femoral diaphysis reported a fracture 1 month after treatment. PC is effective to obtain pain regression in painful bone metastases not responding to conventional analgesic therapy; bone consolidation cannot be obtained in the diaphysis of long weight-bearing bones.

Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis

O tratamento de algumas das fraturas da crianca tem sofrido modificacoes nos ultimos anos, com o objetivo de obtencao de resultados mais satisfatorios, restricao do tempo de incapacidade e para melhor corresponder as expectativas da familia. Isso e especialmente valido para as fraturas diafisarias de alguns ossos longos com o tratamento feito por hastes intramedulares elasticas. Esse tratamento e de baixa morbidade, respeita a biologia e a biomecânica da fratura e permite consolidacao ossea por mecanismo secundario, com a formacao de calo osseo. Entretanto, requer implantes, instrumental e conhecimento tecnico do cirurgiao, pois os maus resultados relacionam-se diretamente com falhas tecnicas. Atualmente, os ossos que mais se prestam para esse tipo de fixacao, em relacao a prioridade, sao: femur, radio, ulna, tibia e umero. O objetivo deste texto de atualizacao foi analisar a literatura e fornecer informacoes fundamentais para o conhecimento do metodo.

How heating and cooling and wetting and drying can destroy dense faunal elements and lead to differential preservation

Recent taphonomic research has demonstrated that bulk bone density significantly determines survivability in many archaeological and paleontological contexts. Researchers often assume that higher density skeletal elements invariably preserve better than lower density skeletal elements. This assumption, however, is not universally valid. Here we present data on the taphonomy and preservation of assemblages from the Geelbek Dunes of the Western Cape Province, South Africa. These data indicate that skeletal preservation of fossil assemblages from deflation hollows can reflect an unexpectedly high proportion of porous, low density skeletal parts. High density skeletal parts including teeth and the shafts of long bones often shatter as a result of the repeated thermal shock and wetting and drying of the kind observed at Geelbek. This effect is greatest for highly mineralized bones from large mammals. The data from Geelbek demonstrate that survivability is affected by the size of the animal. Small mammals are represented by high proportions of non-mineralized, dense, skeletal parts, especially long bones.